Boris Johnson (pictured as his health worsened on April 3) has spent the night in intensive care but there has been ‘no change’ in his coronavirus condition
Prime Minister Boris Johnson was moved to intensive care with coronavirus last night after his health dramatically worsened.
Doctors at St Thomas’ Hospital in London took the drastic step because the 55-year-old was struggling to breathe.
The PM is still battling coronavirus in intensive care today with ‘no change’ in his condition overnight – amid a wave of support from across the nation.
The PM’s sharp downturn came 11 days after he first suffered tell-tale coronavirus symptoms and went into isolation.
He looked increasingly unwell when glimpsed in public and in ‘selfie’ videos posted on on social media, and ministers were then shocked by his grim appearance at a Zoom conference on Sunday.
Downing Street sources confirmed Mr Johnson is not yet on a ventilator – but was moved to intensive care to be near one if needed. Some medical experts fear this course of action is now ‘very likely’.
Here, MailOnline looks at Mr Johnson’s medical history, his struggle with his weight, and what happens in intensive care.
HOW HEALTHY IS THE PM?
WHAT DO WE KNOW ABOUT CORONAVIRUS PATIENTS IN ICU IN THE UK?
The Intensive Care National Audit and Research Centre analysed all admissions to critical care units in the UK up until midnight last Thursday. At that time, there were 2,249 coronavirus patients in ICU.
So, what did it show?
Average age of admission: 60
Men: 1,641 (73%)
Woman: 607 (27%)
The data also showed 62 per cent of the patients were ventilated within 24 hours.
But how likely were they to die?
The report also revealed that 67.3 per cent of patients who needed to be hooked up to a ventilator died.
The Prime Minister has no known health problems and is thought to be fairly fit and well.
Will Walden, a friend of Boris Johnson and his former director of communications during his time as London mayor, said the Prime Minister is a ‘really, really strong guy’ and ‘far fitter than he looks’.
He told BBC Radio 4’s Today programme: ‘He will whip anybody’s backside on a tennis court, he runs regularly, he doesn’t smoke, he drinks moderately.’
The last time he was admitted to hospital was in August 2019 after he stepped on a broken coffee pot in his garden and got glass stuck in his foot. He said the ‘spindly little triangle’ of glass ‘hurt like h***’ for days.
In his eight-year stint as mayor of London, the 55-year-old was known for cycling to work every day and was described as the ‘most famous cyclist in Britain’.
Mr Johnson narrowly escaped being hurt on a narrow road in the capital in 2009, when a lorry dragged a parked car and catapulted it towards his bicycle.
He was forced to give cycling up when he became Foreign Secretary in July 2016 and then Prime Minister last summer because of security precautions.
He admitted struggling with his weight as the foreign secretary under Theresa May’s Government.
Mr Johnson said it was hard to stick to a healthy diet while constantly flying between countries to carry out diplomatic talks.
At his one of biggest points in December 2018, he is said to have weighed 16-and-a-half stone (231lbs) – which would have made the 5ft 9in politician obese. He blamed his size on ‘late-night binges of chorizo and cheese’.
And before taking on a mammoth 100-mile cycle race in 2013, Mr Johnson revealed he was close to 17 stone (238lbs).
In his column for The Telegraph at the time, he joked that his plan to get fitter was called Operation Chiselled Whippet.
He wrote: ‘Since my normal cycling speed is so slow that my wife says it is a miracle I stay upright, I have decided to get in shape.’
Mr Johnson lost 12lbs in two weeks at the end of 2018, and he claimed he was on track to dip below 15 stone (210lbs) for the first time since university.
He said he had taken to ‘guzzling water’ rather than drinking alcohol, writing in the Spectator at time time: ‘I breakfast like some Georgian hermit on porridge with a luxury sprinkling of nuts.’
People with a BMI greater than 30 are thought to be at high-risk of suffering serious complications from coronavirus because of their weakened immune systems and high blood pressure.
But Eton-educated Mr Johnson, who enjoyed rugby and cricket at school, has slimmed down since meeting his new partner and heavily-pregnant fiancee, Carrie Symonds.
Inside No10, he is said to squeeze a daily workout regime into his busy routine which includes yoga, pilates and aerobic exercises.
Mr Johnson – who first took up running in the early 2000s but reportedly gave up recently because of his knees – is an avid tennis player and regularly plays on the courts at Chequers, the PM’s country residence.
Sonia Purnell, author of Just Boris: A Tale of Blond Ambition – a biography about the PM, described him as ‘remarkably fit, considering he is actually a bit overweight’.
Boris Johnson is pictured cycling in 2015 (left) and playing table tennis with pupils from St James’ School in Bermondsey (right)
Mr Johnson joins in for a game of tug of war with members of the armed forces in 2015 at Potters Field in London
Mr Johnson is pictured colliding with a 10-year-old during a game of street rugby in Tokyo
She added: ‘He’s not really that active, his runs aren’t very long or very energetic and he is very fond of cheese.
‘In fact, he likes eating a lot – nothing wrong with that – but he does have a very robust constitution.’
And Ms Purnell added that ‘illness has never really come up’ during the 30 years she has known him. The pair met in the 1990s.
WHAT HAPPENS IN INTENSIVE CARE?
What is an intensive care unit like?
Patients on an ICU will be looked after closely by medics and will be connected to equipment by a number of tubes, wires and cables.
There will normally be one nurse for every one or two patients patients.
Equipment used includes a ventilator (common among coronavirus patients), monitoring equipment, IV lines and pumps, feeding tubes, drains and catheters.
This equipment is used to monitor their health and support their bodily functions until they recover.
Patients in an intensive care ward can often be sedated because some of the equipment used makes them uncomfortable.
Intensive care units throughout the country have been put under immense strain by coronavirus, such that they have stopped or restricted visits.
British medics were clear last night – Mr Johnson would not be in an intensive care unit unless he definitely needed to be.
The move marks a serious escalation in his treatment and will not have been taken lightly by his team of doctors at London’s St Thomas’ hospital.
‘The NHS, particularly in this moment, doesn’t give up intensive care beds just for people to be looked over,’ Reading University’s Dr Simon Clarke said.
Medical teams treating the most seriously ill patients are meant to work one-on-one in the wards and have a host of equipment to measure every aspect of people’s bodies from heartbeat and temperature to their exact blood oxygen level – a key indicator in coronavirus deterioration.
Even within ICU, some patients will be ‘better’ than others. Sources told The Times last night that Mr Johnson had needed four litres of oxygen, compared to 15l for some more desperately ill patients.
At one end of the spectrum, those being treated will remain conscious and ‘continuous positive airway pressure’ or CPAP treatment is used.
With this, patients are put in a hood or tightly fitting mask and oxygen is delivered at higher pressure to keep the airways open. This is especially useful for people suffering pneumonia, which sources denied was the case for Mr Johnson.
But at the other end of that spectrum, mechanical ventilation will be necessary – with the patient placed in a medically induced coma. Tubes will be placed into their windpipes to breath for them and their heart, lungs and other organs will be constantly monitored. Drugs and fluids, as needed, will be dispensed.
Police guard an entrance to St Thomas’ Hospital in London, where Mr Johnson is being cared for, as sources said he is not on a ventilator but doctorss fear he could need one
The ventilators – which use sophisticated software and sensors to adjust the levels of oxygen required – can be administered to a conscious or unconscious patient.
The Prime Minister may be put on an ECMO machine, a highly specialised device that is more sophisticated than a ventilator.
Your questions answered as Boris Johnson is moved to intensive care in his battle against coronavirus
Why did Mr Johnson first go to hospital?
He was admitted to St Thomas’ in London at around 8pm on Sunday, ten days after testing positive. Doctors advised him to seek treatment as his ‘persistent symptoms’, including a cough and a temperature, had not improved. His slow recovery is a red flag for complications including pneumonia. No 10 said it was a ‘precautionary step’ so Mr Johnson could have routine tests, which are likely to include procedures which can only be done in hospital.
What happens in intensive care?
Downing Street said the Prime Minister remained conscious last night and was moved to intensive care ‘should he require ventilation’.
There are two types of ventilators used: non-invasive ventilation and invasive ventilation. Non-invasive ventilation means the patient stays conscious and is given a specialised mask which pumps air at high pressure into the lungs.
These are called continuous positive airway pressure machines. If this does not work, patients are intubated – have a tube put down their throat into their airway – and placed on an invasive ventilator. They have to be placed in a drug-induced coma and paralysed while the mechanical ventilator takes over their breathing. ICU ventilators have built-in sensors to adjust the amount of oxygen the patient needs.
How common is it to be hospitalised and how high risk is he?
The Prime Minister, 55, is one of 17,911 people to have been admitted to an NHS hospital with coronavirus so far.
Latest research estimates between five and ten per cent of those who get the virus end up in hospital. The older you are, the more likely you are to need hospital treatment.
A study found that eight per cent of people in their 50s with the virus need hospital treatment and 0.6 per cent die. Mr Johnson has no known underlying health conditions. But he has struggled with his weight and in December 2018 revealed that he weighed 16 and a half stone.
Obesity is a risk factor for complications and men are more likely to be hospitalised than women.
How long could he stay in intensive care?
Some patients spend just a day there before recovering and going to a general ward. Others have spent more than three weeks in intensive care units.
What initial tests and treatment did he have and why?
Coronavirus is a respiratory disease so initial tests will have focused on establishing how badly his lungs were damaged. Most patients admitted to hospital with coronavirus have difficulty breathing and get oxygen support.
Mr Johnson’s oxygen saturation levels will have been monitored by a sensor clipped to a fingertip. Doctors will also have scanned his lungs.
Other tests establish if major organs have been affected by a lack of oxygen. This includes an ECG and blood tests for the liver and kidneys.
Patients have their white blood cell counts monitored to show immune response.
His move to ICU suggests these key measures, most importantly oxygen levels, were continuing to deteriorate yesterday.
What treatment could he receive?
The highest level is mechanical ventilation, which requires patients to be fully sedated. There are no established drugs for coronavirus and antibiotics do not work on viruses.
Could continuing to work make it worse?
The Prime Minister did not take any time off and vowed to continue leading the Government from his hospital bed.
But this went against NHS advice urging those with coronavirus to get plenty of rest and sleep.
Exhaustion is a common symptom of coronavirus. Previous studies have shown that a lack of sleep and high stress can suppress the immune system.
St Thomas’ is one of just six UK hospitals with a centre for adult ECMO – extra-corporeal membrane oxygenation.
The machines, which take the blood out of the body to remove the carbon dioxide and replenish the oxygen, are used on patients whose lungs are not working properly.
The treatment costs an average of £45,000 a head, but makes recovery much easier because it allows the lungs time to heal.
Wherever course of action his doctors are using on the Prime Minister, medics said being on an intensive care ward – even being in a private room – would be frightening for a patient and could last days even if he is not hooked up to machines.
Intensive care units can be overwhelming places for both patients and their loved ones, although the highly transmissible nature of coronavirus means many hospitals have stopped or restricted visits.
Linda Bauld, a public health professor at the University of Edinburgh, said: ‘The admission of the Prime Minister to intensive care is of huge concern and illustrates just how indiscriminate this virus is.’
WHAT DO WE KNOW ABOUT THE HOSPITAL?
St Thomas’ is a major teaching hospital that specialises in critical care.
It is situated on the Thames opposite the Houses of Parliament and has two intensive care units that house 19 permanent beds.
St Thomas’ also specialises in heart and lung surgery, obstetrics and gynaecology and children’s medicine.
Once a patient no longer requires intensive care they can begin what is often a long road towards a full recovery, although sometimes there are lingering problems.
Health experts say that as a general rule patients will need a week of convalescence for every week that they are in intensive care.
And they agreed tonight that the PM’s admission to intensive care means he is ‘extremely sick’.
HOW LONG WILL IT TAKE HIM TO RECOVER?
It takes several days for a coronavirus patient to develop symptoms, and as long as a fortnight for the infection to become a life-threatening illness.
Boris Johnson revealed he had tested positive for the coronavirus on March 27, after experiencing mild symptoms ‘over the past 24 hours’, including a temperature and cough.
Mr Johnson could have picked up the virus as early as March 13, in which time he mingled with other MPs in the House of Commons and hosted daily briefings in the Cabinet Room. He may have been contagious before his symptoms appeared.
The majority of patients recover on their own within seven days, which is the same duration of self-isolation.
It appears that anyone who has not recovered beyond day seven may be in the danger zone, signalling the patient needs medical intervention.
During the first week, most people’s immune systems are fired up and send out antibodies to fight the virus.
In the second week, those who have not recovered may experience a cytokine storm – when the immune system goes into overdrive and attacks the body’s own organs.
It’s not just the virus replicating in the respiratory tract that causes disease progression, but the bodies’ own response.
Latest research estimates between five and ten per cent of those who get the virus end up in hospital.
A study of 799 patients in Wuhan, 113 of whom died, showed a ten day period between the first symptoms and hospital admission.
Then, on average, death was six days later, according to the findings published in the British Medical Journal.
Mr Johnson was ill for ten days before he was advised to go to hospital, therefore the next few days will be critical for his recovery.
Some people are unable to shake the virus off because of a pre-existing health condition, including diabetes, high blood pressure and heart disease, which puts them at a disadvantage.
There are a number of reasons why their bodies are less able to cope with the stress of an infection.
Their immune system may be slower to detect the virus is in the body, and therefore antibodies are unable to seek the virus and kill it as quickly, giving it time to replicate.
Cancer patients and those with autoimmune conditions such as lupus are at a higher risk because their immune system is weaker or suppressed.
The elderly may see their disease progress for the same reasons. Or, their anti-body rich blood is unable to travel around the body as quickly due to aged blood vessels.
But scientists have warned that the younger, fit and healthy are not exempt from serious illness. It is unclear why, in these cases, the virus is so damaging.
Theories include that the severity of illness depends on how large a ‘dose’ of the virus infected the patient in the first place. There is also susceptibility that genetics play a role, but this won’t be understood for a while.
Early studies have shown that the date between the first signs of the coronavirus and death can be within three weeks.
Imperial College London estimated the mean duration from onset of symptoms to death is 17·8 days using data on 24 deaths that occurred in mainland China.
But Mr Johnson could be out of hospital within two weeks – as the same study found the time from infection to hospital discharge is 24.7 days.
Doctors report a difference in symptoms between those who do and don’t survive. Chest tightness, shortness of breath and loss of consciousness were more common in those who died in the BMJ published study.
WHAT TREATMENTS WILL HE BE GIVEN?
If the infection does start to penetrate deep into the lungs, Mr Johnson could be put on a ventilator and treated with painkillers and antibiotics to try and fend off the life-threatening virus.
There are a number of promising experimental drugs which have shown promise in studies in China.
But none are currently approved in the UK so doctors cannot routinely treat British patients with them until human trials are complete.
A major trial of several promising drugs – including chloroquine – is underway at the University of Oxford, as well as other universities, and health chiefs have urged more patients to sign up to speed up results.
One treatment that has been approved involves patients receiving the blood of Britons who have already fought off the virus, known as convalescent plasma therapy.
It was green-lighted by regulators in the UK last month and is already being used to treat critically ill patients in the US.
It involves injecting patients with the blood plasma of a COVID-19 survivor who has the antibodies necessary for fighting the infection.
Leading British scientists say the therapy could ‘make a life or death difference’ for patients in the most critical states.
Infusing patients with blood plasma has also been used to tackle the similar coronaviruses SARS and MERS, as well as the deadly infection Ebola.
WHAT ARE THE MOST PROMISING DRUGS BEING TESTED?
Hydroxychloroquine – sold as Plaquenil – is a well-established antimalarial available on the NHS which has been used since the 1940s.
It works by dampening the body’s immune response when it overreacts to viruses.
Doctors in Europe, the US and China have been given licence to prescribe the promising drug to COVID-19 patients because it is generally regarded as safe.
There can be a time lag of more than three weeks between someone becoming infected with coronavirus and dying
Early trials in China have shown the tablets can reduce the severe effects of the infection.
The UK has prevented clinicians from giving it to sufferers until human trials are complete, citing the need for further evidence.
Several major trials are testing its effect on COVID-19 sufferers, including one at the University of Oxford.
The HIV drug lopinavir/ritonavir – marketed as Kaletra and Aluvia – is another promising drug being studied by Oxford researchers.
The medicine is given to people living with HIV to prevent it developing into AIDS.
It is a class of drug called a protease inhibitor, which essentially stick to an enzyme on a virus which is vital to the virus reproducing.
By doing this it blocks the process the virus would normally use to clone itself and spread the infection further.
The drug was reported to have successfully cured coronavirus patients in China, but it has not been scientifically proven.
Sold as Ozurdex and Baycadron, it is used to treat allergies and asthma, as well as some types of cancer.
No studies have yet to prove dexamethasone can treat COVID-19- but it has been proven effective on patients with MERS and SARS, two different coronaviruses.
Steroids are often used by doctors to reduce inflammation, which is present in the lungs of patients with the coronavirus.
However, steroids also impair the immune system’s ability to fight viruses and other infections that often develop in patients with life-threatening illness.